The insertion of chest tubes into the pleural cavity of patients suffering from a number of different conditions is a well-established procedure. The indications for closed thoracostomy chest tube insertion vary from the treatment of malignant pleural effusions to the life-saving evacuation of a traumatic hemopneumothorax and the use of closed thoroacostomy chest tube insertion has been well known for decades.
Although the process is considered to be basically effective and safe, there remain certain distinct disadvantages. A fairly large incision with vigorous blunt dissection with clamp or probe is used, sometimes with less than precisely controlled force to enter the pleural cavity. Alternatively, a smaller incision and a trocar within a chest tube that is effectively speared into the patient is sometimes used. With the latter procedure it is possible to pierce the lung and it is often difficult to assure placement in the pleural space desired. Further, the force (and its awkward application some distance from the site of penetration into the thorax) necessary to pierce the chest is sometimes difficult to control. With either of the above techniques, it has been difficult to aim the chest tube with any accuracy (anterior, posterior, inferior, superior or some combination), and this is important for its therapeutic advantage.
Not the least of the problems associated with this prior art technique, are that the patients find the procedure uncomfortable and frequently unnerving when they observe their doctor exerting himself or herself to generate the force required for insertion by the above techniques. Bleeding from the wound and/or from inadvertent puncture of vessels can be a problem. In the trauma patient, the time required to gather equipment and perform the procedures can be critical.
In situations where it is necessary to inject material into the bloodstream, it has been known to place or replace catheters over guide wires. Applicant is not aware of procedures wherein catheters have been placed over guidewires in connection with closed thoracostomy chest tube insertions.